Medical Research about Tuberculosis: Virginia Perspectives on Koch’s Cure

In nineteenth century America, tuberculosis accounted for nearly one out of every ten deaths. Known most commonly as “consumption,” this disease was dreaded across society because it affected all age groups, cut across social and class lines, was incurable, and often resulted in long debilitating illnesses. To explore the social effects of tuberculosis, a group of Virginia Tech undergraduates spent the spring 2015 semester exploring “That Dread Disease,” using newspaper obituaries to document the lives lost to this disease. In this first of three posts, Circulating Now welcomes guest bloggers Phoebe Bredin, Murphy Massey, Andrew Climo, and E. Thomas Ewing, who look at reporting on medical discoveries.

Robert Koch (1843–1910)NLM #B16690

In November 1890, Dr. Robert Koch’s announcement of major advances in the effort to control tuberculosis prompted a great deal of public attention across the United States. Koch’s own account of the discovery, which appeared first in the German periodical, Deutsche Medicinische Wochenschrift on November 14, was published on the following day as an extra edition of the Medical News. In his article, Koch outlined his experiments using his new remedy on more than a thousand human subjects. After detailing preferred dosage and methods, Koch predicted that the treatment would be effective in most cases of glandular, bone, and joint tuberculosis, allowing patients to show improvement. In case of pulmonary tuberculosis (also called phthisis), however, Koch offered the more cautious prediction that while patients treated in early stages “improved considerably and were almost cured,” more advanced cases did not show any improvement. The most important conclusion that Koch drew from his experiments, therefore, was the imperative for early diagnosis and treatment, as the best way of bringing some improvement to patients with phthisis, for “then only will the new therapeutic method become a blessing to suffering humanity, when all cases of tuberculosis are treated in their earliest stages, and we no longer meet with neglected serious cases forming an inextinguishable source of fresh infections.”

The publication of Koch’s article in America only a day after it appeared in Germany testifies to the global fascination with research on tuberculosis. Over the next few weeks, the same article was republished in many other American medical journals, including the Virginia Medical Monthly in February 1891. The republication of the article provides further evidence of how the medical community sought more information about Koch’s new technique for treating, and possibly curing, this deadly disease.

Title page: Virginia Medical Monthly, Vol. 17, No. 11 (February 1891)

Yet interest in Koch’s work was not limited to scientists and doctors. A research team of Virginia Tech undergraduates has been exploring the ways that Virginia newspapers covered Koch’s research as a way to understand more fully the history of consumption in a the context of American society. Using the Chronicling America database of digitized newspapers, these researchers located approximately thirty articles that included the key words “Koch” and “consumption” or “tuberculosis” from November 1890 to January 1891. This careful examination of newspaper reporting is a productive technique for understanding both the great hopes invested in leading scientists and the appropriate level of skepticism about claims of easy cures during this period of intense interest in tuberculosis.

Even before the publication of Koch’s article on November 14, 1890, Virginia newspapers printed reports from Berlin about possible treatments and cures. On November 4, the Alexandria Gazette reported that Dr. Koch’s discovery “is a chemical substance, which is injected into the body, and that it even checks cases of advanced tuberculosis.” Three days later, The Times from Richmond published a cable from Berlin which described how patients undergoing the treatment were “under a promise not to divulge anything relating to Professor Koch’s experiments.” Despite this secrecy, the report cited rumors that several consumptive patients had seen improvements after “five or six injections of the lymph,” while full recovery was occurring after months of treatment. In the same issue, but in a separate article, The Times reported that Koch’s discovery of “a method for the cure of consumption by inoculation with attenuated tubercular bacilli is exciting the greatest interest among the medical profession and laymen.” This report’s final sentence would prove ironic given later concerns about the tension between scientific research and commercial gain: “The Professor states that he is not desirous of deriving material or personal advantage from the discovery, and says that he will make public his method in all its details for the benefit of humanity.”

Soon after Koch’s article appeared in medical journals, Virginia newspapers reported on his discovery, often with extravagant editorial praise. The Roanoke Times reprinted an Associated Press report under the headline: “Koch’s Method a Success. To Consumptives Come Tidings of Great Joy.” The opening paragraph clearly evokes the global fascination with this medical discovery: “Prof. Kock [sic] holds supreme sway over public interest. The publication of the professor’s statement yesterday has intensified the excitement, both here and abroad, and from every center of Europe and America telegrams of inquiry are pouring in….” After quoting a simplified explanation from one of Koch’s colleagues, the article described the apparent “cessation” of consumptive disease in a forty-two year old man, who was expected to live a much healthier life after the experimental treatment.

Yet only a week later a Richmond Dispatch headline suggested a shift in public perceptions: “The Great Cure. Growing Disappointment Among Those Who Expect Too Much.” After describing the unprecedented honors bestowed on Koch by the German Emperor, this Associated Press report declared that “public disappointment over the immediate results of the treatment grows daily.” Although nearly two thousand patients have been treated, most of those showing improvement were ill with glandular, bone and joint tuberculosis, with “comparatively few cases of tubercle on the lungs,” so the treatment of this most dangerous forms of the disease is “uncertain,” in the opinion of medical experts. Professor Koch and his colleagues blamed the press “for raising exaggerated hopes of instant benefit in every form of tuberculosis.” Several international doctors in Berlin observing the experiments predicted that a cure for consumption was unlikely soon, or even at any time.

At the end of November, newspapers began to report on the deaths of patients with advanced tuberculosis who were being treated in Berlin with Koch’s lymph. Yet Koch’s celebrity status persisted. On December 24, 1890, the Staunton Spectator offered this laudatory praise: “In view of the great stir recently made over the invention of the great German bacteriologist by which it is expected to mitigate, at least in large measure, the scourge of tuberculosis in the human family, and reduce the enormous death rate it produces, Dr. Koch has naturally become a most attractive and popular figure. All the world now reads, talks, and thinks of Dr. Koch.” An equally flattering article appeared in the Roanoke Times on January 11, 1891, under the headline, “A Great Physician. Humanity’s Debt to Dr. Koch, the Berlin Scientist. Even if His Tuberculosis Lymph Should Prove a Failure He Would Still Live as One of the Greatest Benefactors of Mankind.” Among Koch’s great contributions to humanities was the claim that his discovery was saving as many as 800,000 lives every year. The drawing of Koch, along with his signature, confirmed that he had become a recognizable figure for the general public.

During this same period, the Virginia Medical News provided more expert analysis of Koch’s breakthrough, including two reports republished from the Times and Register from prominent physicians who observed Koch’s laboratory. Perhaps the final word on how Virginians responded to Koch’s discovery appeared in that same issue, under the headline: “Koch’s Lymph in Therapeutics.” The editors declared that their position regarding this announcement that so “excited the world of doctors and patients with consumption” is “to take a conservative view of the facts—neither denying nor claiming too much.” Yet the editors indicated their position more clearly when they compared Koch’s “methods of secrecy” to those “manufacturers of proprietary preparations,” leading to a final judgment that clearly expressed disapproval of both Koch’s approach and his underlying motivations: “Concealment of his methods of manufacture has been so long, and yet the sale of the lymph has been so large and the pressing demand to know so great that one is forced to the conclusion that Dr. Koch’s secrecy has been measurably prompted by other and less noble purposes than doing good to humanity.” Even with this criticism, however obliquely, this regional medical journal endorsed the qualified claims that Koch had himself made two months earlier when he announced an important advance in the diagnosis and treatment of certain kinds of tuberculosis, but also acknowledged that he had not yet discovered a cure for the most serious forms of consumption.

In these posts Virginia Tech students, working under the direction of Professor Tom Ewing, explore themes related to tuberculosis, including reporting on medical discoveries, the cultural implications of advertising cures, and techniques for measuring the impact of this disease. By studying these patterns in the past, historians of medicine can contribute to contemporary and future responses to infectious diseases. This research made extensive use of the digitized collections of the National Library of Medicine as well as Medical Heritage Library in the form of national and Virginia medical journals, photographs and other images, and published books. More information about the project, including an online presentation documenting Virginia lives lost to tuberculosis, is available from the project site: http://ethomasewing.org/tbhistory/

Phoebe Bredin is a Geography and Biological Sciences major at Virginia Tech.

Murphy Massey is a Biological Sciences major at Virginia Tech.

Andrew Climo is a History major from Virginia Tech.

E. Thomas Ewing is Professor of History and Associate Dean in the College of Liberal Arts and Human Sciences at Virginia Polytechnic Institute and State University.

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One comment

Robert Koch was truly a giant in the annals of medical discovery. I suspect that Koch’s lymph treatment was facilitated by the easy accessibility of tuberculous lymph nodes in the neck, so called scrofula. The world would have to wait half a century for the first truly effective treatment of T B from the lab of Schutz and Waksman at Rutgers University. The discovery of streptomycin was electrifying to the medical community. Tuberculosis for the first time was actually being cured. The euphoria unfortunately was short lived; within six months resistant strains began to emerge. Then the long saga of more and more drugs for ever increasing resistance to the point now of multidrug and even totally drug resistant strains.